January 19, 2012. Governor Pat Quinn today announced a plan to rebalance the state’s approach to care for individuals with developmental disabilities and mental health conditions. Called the Active Community Care Transition (ACCT) plan, the initiative will increase the number of people with developmental disabilities and mental health conditions living in community care settings across Illinois. Under the first phase of the plan, residents of Jacksonville Developmental Center (JDC) in Jacksonville, IL and patients of Tinley Park Mental Health Center (MHC) in Tinley Park, IL will be transitioned to community settings and the facilities eventually closed.

“My administration is committed to increasing community care options and improving the quality of life for people with developmental disabilities and mental health conditions,” Governor Quinn said. “The approach we are taking will allow for the safe transition of care for some of our most vulnerable citizens to community care settings. I want to thank the members of the public, the General Assembly and advocates who worked with my administration to meet this challenge and help our state move forward.”

Rebalancing Background

In November, the Quinn administration announced its intention to rebalance Illinois’ use of institutionalization for the care of people with developmental disabilities. Illinois lags behind the rest of the nation in the utilization of person-centered, community-based care, which has been demonstrated to allow people with developmental disabilities to lead more active, dynamic lives.

Community settings allow individuals to receive the care they need – including 24-hour care – in their hometown and even their family home. Community care can also be significantly less costly than institution-based care. The ACCT also dovetails with the administration’s recent settlement of a series of court cases related to the Americans with Disabilities Act, requiring the expansion of community care settings.

The administration has worked collaboratively with the General Assembly on this initiative, receiving valuable input from members of the Commission on Government Forecasting and Accountability (COGFA) following public hearings in October and November. The General Assembly also worked with the administration to reallocate funds to allow continued operation of all state facilities through the end of Fiscal Year 2012 (June 30, 2012).

In December, the administration created a bipartisan and bicameral working group, with members appointed by the four legislative leaders, to seek input on the rebalancing and closure process. Incorporating their input, the administration developed a series of objective criteria to determine the facilities that will transition to closure, including ability to recruit staff, economic impact, certification status and physical condition. As different issues affect the Division of Developmental Disabilities and the Division of Mental Health, 10 criteria were developed for the former, 18 for the latter.

The ACCT is a policy decision that also has positive fiscal benefits for the state. In addition to improving quality of life for hundreds of individuals across the state, the move is expected to save the state of Illinois $19.8 million annually, and allow for alternative uses of some of the state’s costliest facilities.

Transition Plan Development and Implementation

To accomplish the plan safely and effectively, the administration brought on Mark Doyle as the state’s Transition of Care Project Manager in October. Mr. Doyle has 33 years of experience in the disability community and has worked in several states to expand community care options and move away from institutionalization. Mr. Doyle is nationally known for his work in the area of community integration and inclusion of people with disabilities in all areas of life. He is highly recognized for his involvement in providing technical assistance to states, community provider agencies, schools and parent groups to create successful community integration.

Mr. Doyle, working alongside senior members of the administration and the Department of Human Services (DHS), developed the ACCT, which includes a comprehensive plan to build additional community capacity and infrastructure for care, as well as a grant to hire nationally-recognized Community Resource Associates (CRA) to conduct independent needs evaluations of each resident of state facilities to ensure they have the resources they need for a successful transition to community care.

The ACCT calls for a “person-centered approach”, meaning that individuals and their families will be a significant part of designing the program that best fits their needs and desires. In accordance with the ‘money follows the person approach’ to rebalancing, after evaluations, each transitioning resident will receive an individualized budget based on their particular support needs. Those with more challenging needs will receive more funds for their care with the average anticipated budget of $7,000 a month per person. The smaller community care options will also allow the state to utilize federal funding for this purpose, reducing state costs.

While there are numerous community care settings currently available in Illinois, the increase in the number of individuals using community care will require the state to develop new settings and options. Unlike state institutions, which may be hundreds of miles from an individual’s hometown, individuals and families will have the choice of community in which their care options are developed. Options will also be available for community care at home, if the individual and their family desires.

The ACCT will also utilize both family-to-family and individual-to-individual mentoring strategies, so that individuals and families will know what to expect and have a support system in place during and after transition. For interested individual and families, the state is also establishing microboards and cooperatives to guide and develop person-centered services options. The administration will work closely with the Illinois Association of Microboards and Cooperative in educating individuals and families as well as providing the technical assistance for those interested in that option.

In DHS’ Division of Developmental Disabilities, a total of 600 individuals will transition into community settings over the next two and a half years, allowing DHS to close up to four state institutions, the first of which will be JDC. Working with the individual, parents and guardians, residents at JDC will be evaluated to determine their needs and their individualized and appropriate community care option. A good match between the individual’s needs and community care option is essential to ensure a successful transition.

“Community-based care is about quality of life,” director of the Division of Developmental Disabilities Kevin Casey said. “Through this careful, deliberate process, Illinois will improve quality of life for hundreds of people with developmental disabilities, while realizing significant savings through the closure of a costly state facility.”

One of the advantages of community care is its much lower cost compared to institution-based care. For people with developmental disabilities, the state spends on average, between $150,000 and $210,000 per person per year in a state facility, versus the $45,000 to $84,000 per year average in community care.

Matching individuals with both existing and new providers, the ACCT calls for 20 residents a month to move from JDC into community care settings. JDC is anticipated to complete transitions in time for an early October 2012 closure.

Division of Mental Health – Tinley Park MHC

In the Division of Mental Health (DMH), Tinley Park MHC will be phased out, with an increase in capacity at community providers and hospitals in the area for those with acute mental health conditions. Tinley Park MHC currently serves only acute-care patients, whose treatment periods usually last between 24 hours and 21 days. Admissions will be halted, allowing all patients to complete their course of treatment before the anticipated early July 2012 closure. Patients with challenges that require ongoing care will be transitioned to care at community providers or hospitals.

Aside from forensic patients remanded into state custody by the courts, state-run mental health facilities primarily serve acute care patients who do not have access to health insurance or Medicaid. As the Affordable Care Act continues going into effect, many people currently without access to health coverage will attain it, reducing the number of beds needed in state-run psychiatric hospitals and mental health facilities. The DMH, however, is actively securing additional beds at community providers and hospitals in the area surrounding Tinley Park MHC to ensure that services in the area are not interrupted.

“The health and safety of those with mental health conditions is our primary concern,” director of the Division of Mental Health Dr. Lorrie Jones said. “This transition will allow us to expand our community and hospital partners while ensuring continued care for those with mental health challenges.”

Closure of Facilities

While improving quality of life is the fundamental purpose of the ACCT, closure of state facilities is expected to save the state of Illinois significant annualized costs. Facilities chosen for closure were evaluated based on 10 objective criteria developed by the administration, with input from members of the legislative workgroup. The first phase of this transition will allow the state to close JDC and Tinley Park MHC, two of the state’s oldest, most inefficient, and costliest facilities to run.

JDC currently costs the state approximately $27.9 million per year to run. After accounting for state costs under community care, Illinois will realize approximately $11.7 million per year in savings, after $16.2 million in community investment. Tinley Park MHC would cost $20.6 million to run in FY 2013. Savings following the closure of Tinley MHC are expected to be approximately $8.1 million after a $9.8 million reinvestment in community services for individuals with mental health challenges.

The physical condition of the facilities was a vital criterion in considering which facilities to transition to closure. Parts of JDC date from the 1850s, and the coal boiler at the facility spends $1.2 million in coal per year, or about $7,000 per resident to heat per year. Of the 8 buildings at Tinley Park MHC, only 5 are operational. The facility was decertified by the federal government in 2009, with recertification unlikely. The Tinley Park facility also shares a campus with the previously closed Howe Developmental Center, preventing the sale of prime real estate for development in Chicago’s south suburbs.

Economic impact was also a criterion in evaluating facilities for transition to closure. The administration realizes that the closure of state facilities will have an economic impact on Jacksonville, Tinley Park and their surrounding communities. However, an Economic Impact Index examination demonstrated that the impacts on Jacksonville and Tinley Park were among the lowest of communities with state facilities.

The JDC currently employs 379 and Tinley Park MHC employs 175 people. Many of these jobs, however, will be absorbed into the local communities. As part of the ACCT development, the Illinois Department of Employment Security (IDES) ran a survey of employers in the counties surrounding each state facility for job openings with titles matching those at each site (i.e., registered nurse openings in the Jacksonville area). As of January 9, 2012:

The development of community care in these areas will also result in additional job creation in these areas.

The administration will provide regular updates to families, communities, unions, advocates and legislators on the first phase of the ACCT, as well as announcements later in the year for phase two and beyond as Illinois continues its transition to increased community care options.

You say this will help the state regain some financially. Well, have you considered at all the residents of JDC. I know there is at least one Adult there that has lived there his whole life since the age of 3, he is in his 40’s now. There are those at JDC like my son who CANNOT adjust to life in the Community in a GROUP HOME! I know because we have been there, and done that. He functions best in a more structured environment like JDC. And are you even considering the feelings of family members you move them to other locations,(hope you will keep at least one or two open) how often will they get to see their familiies. I used to have to drive to Centrailia to see my son, that for me was at least a 5 1/2 hour drive one way. I have to eat the cost of the gas and food and if foul weather possibly lodging. I live in north central Il why not open centers NEW ONES that will be close to the families of these men and women. Consider the HUMAN factor instead of the MONEY BOX.